[McGregor's flap: a salvage technique: about a case, clinical features and outcome]. / Lambeau de Mac Gregor, solution de sauvetage: à propos d'un cas, clinique et résultat.

Inguinal flap is a distant axial pediculated flap. This flap is reliable in covering large losses of substance of the upper limb. Its major drawback is that it requires two-step surgery. Inguinal flap is the elective method in the arsenal of emergency left hand surgery or in common left hand surgery. This is due to its greasy thickness and its short small pedicle, with frequent anatomical variations. The purpose of this study was to show its role imbalance out its advantages and its disadvantages. We report the case of a 33-year female patient presenting with severe deformation with closure of the anterior commissure and first metacarpophalangeal joint ankylosis after complex open trauma of the hand. The patient underwent two-step surgery with opening the first commissure and trapezio-M1 arthrodesis stabilized by plug insertion followed by immediate skin coverage by McGregor's inguinal flap and after 21days by weaning and donor site suture. Anatomical and functional outcome was good. The patient was satisfied with the scar at the donor site, which could be easily covered with clothing, by the functionality and aesthetics of the hand. McGregor's flap is an attractive solution for coverage with significant advantages from a functional and aesthetic point of view. Its role should be enhanced in the therapeutic armamentarium of flaps for limb coverage.

Erecta dislocation of the shoulder joint-A rare injury: About four cases.

A nonresolving axillary nerve injury is a rare associated complication to an inferior dislocation of the shoulder joint. This worsen the midterm outcome of the shoulder. So, neurovascular status must be checked by regular clinical testing and by an electromyography in all cases of inferior dislocation of the shoulder joint.

[Fracture-separation of the medial clavicular epiphysis: about 6 cases and review of the literature]. / Fracture-décollement de l'épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature.

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.